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HomeMy WebLinkAboutCONCRETE STRUCTURES INC - INSURANCE CERTIFICATE-Gwlemt*: ausu UUUNG5 1 K ACORU. CERTIFICATE OF LIABILITY INSURANCE 0DATE 3/26/10D/rr'Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 720 South Colorado Boulevard HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 60ON Denver, CO 80246 INSURERS AFFORDING COVERAGE NAIC # IN INSURER A: Valley Forge Insurance Company 20508 Concrete Structures, Inc. INSURER B: American Casualty Company of Reading 20427 4325 Hilltop Road INSURER C: Pinnacol Assurance 41190 Longmont, CO 80504 INSURER D: Transportation Insurance Company 20494 INSURER E: ` COVFRAGFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 SR LTR ADD NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERAL LIABILITY 2047965998 11/30/09 11/30/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED nce $3OO OOO MED EXP (Any one person) $5 000 CLAIMS MADE a OCCUR PERSONAL &ADV INJURY $1 00O 000 X AI# G140331A 01101 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 _ POLICY X PRO- JECT X LOG D AUTOMOBILE LIABILITY X ANY AUTO 2047965984 11/30/09 11/30/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS - BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO H $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY 204966004 11/30/09 11/30/10 EACH OCCURRENCE s4,000,000 _x1 OCCUR CLAIMS MADE AGGREGATE s4,000,000 $ RDEDUCTIBLE $ X RETENTION $ 10000 C WORKERS COMPENSATION AND 4103172 04/01/10 04/01/11 TH- X WC MITTU� ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 OO,000 E.L. DISEASE - EA EMPLOYEE $100,000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT s500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project Description: Whitcomb and Magnolia Bridge Replacement Project Number: 7081 The following. are Additional Insureds as respects General Liability only (See Attached Descriptions) %.c r— City of Fort Collins 215 North Mason Street, 2nd Floor Fort Collins, CO 80524 (GANGtLLJA 1 IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001/08) 1 of 3 #M667488 8VMAN © ACORD CORPORATION 1988